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Dramatically escalating the fight against heart attacks and strokes, cardiologists in the United States have rewritten the guidebook on how people should be treated with statins and unveiled a plan that could double the number of patients taking the cholesterol-lowering drugs.

The new approach, presented on Tuesday by the American College of Cardiology and the American Heart Association (AHA), represents a stark shift from the way doctors have prescribed the popular drugs for most of the last decade. The guidelines are likely to be followed across the US and influence treatment worldwide.

This is a dramatic change from the 2002 cholesterol guideline

AMERICAN HEART ASSOCIATION

Doctors who have focused on reducing the "bad" LDL cholesterol of patients who are at greatest risk of a heart attack will now be urged to refocus their efforts on using statin therapy on a wider range of at-risk patients, many of them still relatively healthy, to drive down their odds of a heart attack or stroke.

The guidelines dropped an emphasis on targets for lowering LDL levels and suggest that individual patient risk of developing heart disease rather than an LDL number should be used to decide the need for statins.

There had been an expectation that the new guidelines would set a new, lower LDL target for heart patients.

"This guideline represents a departure from previous guidelines because it doesn't focus on specific target levels of (LDL) or bad cholesterol, although the definition of optimal LDL cholesterol has not changed," Dr Neil Stone, lead author of the cholesterol report, said. The AHA said: "This is a dramatic change from the 2002 federal cholesterol guideline."

Until now, treatment with cholesterol-lowering drugs in the US has generally been limited to patients with a 20 per cent probability of a heart attack over the next decade - roughly 36 million Americans. The expanded treatment guidelines would roughly double that figure to 70 million, the authors said.

The long-awaited new guidelines still emphasise a healthy diet and exercise as keys to avoiding the No1 killer in the US.

The cholesterol management guidelines, if followed in practice, could lead to more extensive use of high potency statins, such as AstraZeneca's Crestor and higher doses of Pfizer's Lipitor, now available as generic atorvastatin. They could also lead to reduced use of lower-dose generic statins and perhaps far less use of non-statin cholesterol medicines.

"Non-statins didn't provide enough risk prevention," said Stone, the report's author. He noted that there had been "over-treatment by drugs not proven to add incremental benefit".

The four groups deemed most likely to benefit from higher intensity statin treatment are: patients with known heart disease; those with an LDL level of 190 or higher; patients with type 2 diabetes between the ages of 40 and 75; and those between 40 and 75 deemed to have a 10-year risk of developing heart disease of 7.5 per cent or higher based on new risk assessment formulas.

Additional reporting by McClatchy-Tribune, Agence France-Presse

This article appeared in the South China Morning Post print edition as: